Overview
Study start date is on Nov 27th 2024.
A patient with an initial ejection fraction (EF) of less than 40%, whose follow-up shows an improvement to an EF of 50% or higher, along with the left ventricular end-diastolic diameter returning to the normal range and taking 3 more heart failure medication randomed to drug tapering group ( RAS blocker or beta blocker) or continuing medication group.
Description
Patients described above randomly assigned to drug tapering group and drug maintaining group.
Drug tapering group is 2 groups, which one is RAS blocker tapering group and others is beta blocker tapering group.
Drug tapering group is monitored ejection fraction, LV dimension and LV GLS by 1-3 month.
Eligibility
Inclusion Criteria:
- initial echocardiogram ejection fraction less than 40%
- follow up echocardiogram ejection fraction over 50% and LVEDD index normal range
- NTprobnp criteria
- eGFR ≥60 ; less 440
- eGFR 45-59: less 980
- eGFR 30-44; less 1220
- eGFR \< 30 : less 5300
- in HD; no criteria for NTproBNP
- on more than 3 heart failure medication ( RAS blocker, beta blocker, mineral corticoid receptor antagonist, SGLT 2 inhibitor)
Exclusion Criteria:
- under age 18 year
- uncontrolled BP ( over 150/90)
- coronary revascularization within 6 months
- significant valve disease
- arrhythmia requiring rate control
- CKD with albuminuria ( over 30mg/g)
- Pregnancy
